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HomeMy WebLinkAboutBLD2004-00833 1111J ILDING PERMIT APPLICA BLD04-00833 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00833 Received Date: 12/30/2004 SITE ADDRESS: 111 HAYDEN ST PORT HADLOCK, 98339 OWNER: OTTO J M SMITH PHONE: 111 HAYDEN ST PORT HADLOCK WA 983399521 SUBDIVISION: PHILLIPS ADDN TO IRONDALE Block: 5 Lot: 1-5+ PARCEL NUMBER: 986400501 Section: 2 Township: 29 N Range: 01 W- CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI REPAIR FOUNDATION - NO CHG IN FOOTPRINT - t✓'►re P1° -/ Cfr" U- NO MLA RQD i bN,(LALwa,,t& l pt �^„ (�, o�'. S�YODON5 TYPE OF WORK RES SQUARE FOOTAGE: �` ' TYPE OF IMP REP aI0O0 MAIN: 932 VALUATION -'fie' ADD'L: HEAT TYPE: PRO CODE EDITION: 2003 HEAT BASE: HEAT YPE: OCCUPANCY: UNHEATED: #OF TORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: PARCEL TAGS` YES NO BEDROOMS: BATHROOMS: STORMWATE�R: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Streams Total: Total: Flood Way Floodplain Routing Date: T F&W Landslide 101) (, , Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: w Argii/Datev LPermit $153.25 KAS 01/03/05 69016 S1, Plan Check $99.62 KAS 01/03/05 69016 State Building Code $4.50 KAS 01/03/05 69016 JAN 1 2 2005 Total: $257.37 Jefferson County Planning lit & Build' g Department I 4,� "5" coG DEPARTMENT OF COMMUNITY DEVELOPMENT 1� 621 Sheridan Street,Port Townsend,WA 98368 l` eifir -4 Tel:360.379.4450 Fax:360.379.4451 Web:www.co.jefferson.wa.us/communitydevelopment Sys f' E-mail:dcd(ico.jefferson.wa.us CERTIFICATE OF OCCUPANCY PERMIT#: BLD04-00833 APPLICANT: OTTO J M SMITH PHONE: APRIL SMITH PO BOX 1981 PORT TOWNSEND WA 98368 SITE ADDRESS: 111 HAYDEN ST Issue Date: 01/12/2005 PORT HADLOCK, 98339 Final Date: 12/14/2015 SUBDIVISION: 9864 - PHILLIPS TO IRONDALE Block: Lot: PARCEL NUMBER: 986400501 Section: 2 Township: 29 N Range: 1W PROJECT DESCRIPTION: REPAIR FOUNDATION AND STRUCTUAL REPAIR OF BEDROOMS - Fireplace & Chimney NO ChG IN FOOTPRINT - NO MLA RQD THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 12/14/2015 Building Official, \\tidemark1datalforms\FBLD Occupancy.rpt 12/16/2015 OWNER BUILDER STATEMENT The signer of this/ t does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that � • they will be assur nil- ,••nsibility of the General Contractor for the proposed project. I I i/ Signature: k.'411t1_�I,I Date: 6 e c j 0 0 9 // 1 I GENERAL f •NTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: D New A Wood Existing: Dvl e ❑ Sewer ❑ Addition 0 Steel Proposed: Bank 0 Community System O Alteration/Remodel ❑ Concrete Total: Height: x Individual System K Repair 0 Masonry SEP Permit# Sep Oy-310 ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: rwr) Setback: 0 Private well 0 Two Party Type of Heat: Proposed: ,1?ef Public pr o pay o e Total: Name of System: eKig, If this is a Commercial Project you must answer the followinst: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this Is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: o Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove 0 Cook Stove ❑ Woodstove 0 Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove 0 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage For Office Use Only --;-.1.2,14, Current Proposed Amount ,r"'s 1 F 9F Main Floor , Consistency Review: - qu4 •, ,,..5.7,- ii,,....vs . 2Nu Floor Sgiffitfee: t1 3 Floor °Atdditional Section: 1 Mezzanine: Plan Check fee: In ,,r . max 4 ` .. .- 1D Heated Basement State Surcharge f Mks + rsLa t i Unheated Basement Pot Wates47,414004‘.„,-' ..!+ :f'h• ,< 17...It7„.1A',Other Unheated 911/Rd �` 7 r + Approach fee: � x . Garage/Carport DEC 3 0 2004 TOTAL $ , ' : 1 . Ox e44,,eno �, JEFFERSOt UNTY ' 'v,4 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 f5 "'� ISZtrNO O www.co.efferson.wa.us/commdevelo ment f 360/379-4450 . 360/379-4451 Fax � S Master Permit Application 3 0DEC LA: Project Description(include separatetsheets as necessary): T �n if2-€190, [2 A r.6 v -6^v L.4... !-104 u r 1 1 1 r 'ter 1✓ ©elti7 ax Parcel Property / "y. Number: or,. y �( I Size: �gtia .< v ,{'1- (acres/square feet) Site Address and/or Directions to Property:! //f Ha vele i Sr' POP'T lla� I OC,K Wu 9g 33r Property Owner(s)of Record: 0fro 1- A p r i� / )rM t fl-i Telephone: 3!r2 0 ..3/c(. Co--S 6'3 Fax: /n� �jQ / o email: . Mailing Address: P.O. 1 y81 ?cvT TOt..0it5.PV1cX IA. c< . CO,9 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ){Building U Variance(Minor,Major or Reasonable Economic Use) D Demolition Permit U Conditional Use[C(a),C(d),or Cj** }Single Family O Discretionary"D"or Unnamed Use Classification U Garage Attached/Detached 0 Special Use(Essential Public Facilities)** ❑Manufactured Home U Boundary Line Adjustment U Modular U Short Plat** ❑Commercial* D Binding Site Plan** ❑Change of Use U Long Plat** U Address ❑ Road Approach U Planned Rural Residential Development(PRRD)/Amendments** D Propane U Plat Vacation/Alteration** U Mowed"Yes"Use Consistency Analysis D Shoreline Master Program Exemption/Permit Revisions** U Stormwater Management D Shoreline Management Substantial Development"* U Site Plan Approval Advance Determination(SPAAD)* D Shoreline Management Variance D Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment U Wireless Telecommunication* U Jefferson County Shoreline Master Program Amendment U Forest Practices Act/Release of Six-Year Moratorium *May require a Pre-Application Conference **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). GINNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which m ;i any way accrue against Jefferson County as a result of or in consequence of the granting of this permit I further agree to(I• access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any J• .l,- = inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. ��i�rli - r /� Signature.N:fA4UII Date: VP: 505 ArWy ,. e. r The action .r ac'• < Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered sp-«- -nd could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered S.7 '-. Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has bee"iss'ed will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even,,iyi are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tray;:i-•ii responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and d it below. IAMB n 795 Signatur.�1��. -- - Date: pec._ 1, G:\PemritC4rer\F•I. \DRD FORMS\Master Permit Application 7-8-04.doc li - - -iItT1ITTh 1 m ! f ! 1 I 1 ! 1 ' I 1 tij ! 1 , ' I I ' 1 I • I I I 1 , 1 1 ! . , 1 -r! f 1 P v g. 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D rmirn rn RESIDENCE FOR: OTTO PARTIAL FLOOR PLAN -12-1 TAYLOR STREET rn t�t� '� SMITH I PORT TOHN`+END,HA 96368 I' D III HAYDEN STREET PHONE: (360)319-8090 PAX: (3601 319 8324 PORT HADLOGK, WA 183341 ELEVATIONS FAX: ( b0)3 1-8 BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD04-00833 Received Date 12/30/2004 I SITE ADDRESS: 111 HAYDEN ST Issue Date 01/12/2005 PORT HADLOCK, 98339 APPLICANT: OTTO J M SMITH PHONE: 111 HAYDEN ST PORT HADLOCK WA 983399521 SUBDIVISION: PHILLIPS ADDN TO IRONDALE Block: 5 Lot: 1-5+ PARCEL NUMBER: 986400501 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: REPAIR FOUNDAT O AND STRUCTUAL REPAIR OF BEDROOMS - Fivt_Ptd+-/ `l`emh. NO CHG IN FOOTPRINT - NO MLA R 1D CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: EX/37/,UL UFFER: do Footing: IMT - OW 2/4.54/CGteeoaeo,rs Foundation: dk' z/i/S /114Pc'G ;.�)C,arLb pg -12-1,)6 Stormwater FINAL Approval: J Underground Plumbing: Underground Insulation: Shear Wall : Framing: )'L_ "/"// 46— Plumbing' 1 0 coiritl 64 Propane-fink/ Lin s: - o n,._- - • - :,..r_�- SeE aS ar��t. Insulation: 57 k7 Sheetroc : / Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: ta,-l`-k- l5 OK" ;Cm HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY I:1F_BLD_Perm it_Bu ildng.rpt 10/29/19